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Currently filtering by tag: Renal transplant

Adenovirus

This allograft biopsy shows the characteristic features of adenovirus infection. There is prominent interstitial hemorrhage and edema (Fig. 1), acute tubular injury with viral cytopathic effect and positive immunohistochemical cytoplasmic and nuclear staining for adenoviral antigen (Fig. 2), and foci of tubular necrosis (Fig. 3). The differential diagnosis for this morphology in the transplant setting includes other viral infection (e.g. polyomavirus, CMV, HSV), acute rejection, and drug-related acute interstitial nephritis.

Chronic Active Antibody-Mediated Rejection

A diagnosis of chronic active antibody-mediated rejection (ABMR) requires morphologic evidence of chronic tissue injury (e.g. transplant glomerulopathy), evidence of current or recent antibody interaction with the vascular endothelium (e.g. linear C4d staining of peritubular capillaries), and serologic evidence of donor specific antibody (DSA) formation.  Importantly, the revised 2017 Banff classification of ABMR and T cell-mediated rejection (TCMR) recognizes C4d positivity as a substitute for DSA for diagnosing ABMR, although DSA testing is still strongly encouraged (see reference).  The images are from a patient with an elevated serum creatinine who had undergone living unrelated kidney transplant four years ago.  The...

Chronic Active T Cell-Mediated Rejection

Chronic active T cell-mediated rejection (TCMR) was included in the 2017 Banff classification system for the evaluation of kidney allografts (see reference).  This diagnosis recognizes the usually deleterious effects of interstitial inflammation on graft survival, even within areas of interstitial fibrosis and tubular atrophy (IFTA).  The biopsy shows severe chronic inflammation (Fig. 1) in the setting of moderate to severe IFTA (Fig. 2), as well as foci of severe tubulitis in non-atrophic tubules (Fig. 3).  Haas M, Loupy A, et al.  Am J Transplant. 2018 Feb;18(2):293-307. PubMed PMID: 29243394

Diagnose This! (March 19, 2018)

What is your diagnosis in this renal transplant biopsy?   ​   ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​     ​...

Proliferative Glomerulonephritis with Monoclonal IgG Deposits

This biopsy was performed on an 81-year-male, status post renal transplant, who presented with increased creatinine (2.3 mg/dl) and microscopic hematuria. Light microscopic examination of the biopsy shows diffuse mesangial and mild endocapillary hypercellularity with rare double contour formation of the capillary loops (Fig 1 and 2). No significant tubulointerstitial inflammation, peritubular capillaritis or endothelialitis is present, to otherwise suggest and underlying component of acute T-cell or antibody mediated rejection. Immunofluorescence (Fig 3) shows mesangial and segmental capillary loop positive staining for IgG (3+), C3 (3+), C1q (1+) and lambda light chain (3+). All other stains, including kappa light chain...